By Dr Nick Proctor and Louisa Oliver Byrne, expert trainers of CELforPharma's Understanding Pharma Market Access in the US
The US market access system can be difficult to navigate for European pharmaceutical professionals because it uses different reimbursement structures, payer types, and pricing benchmarks.
Terms like WAC, ASP, PBM, and 340B appear constantly in US market access discussions, but their meaning is not always intuitive if you come from a European pricing and reimbursement background.
This glossary explains key US market access terms in plain English, so you can contribute more confidently to global access discussions, understand US payer terminology, and work more effectively with US colleagues and stakeholders.
This page covers a selection of important terms.
For the complete list, download the full US Market Access Glossary PDF below. 👇
Why US market access terminology matters for European pharma teams
European market access professionals moving into global or US-facing roles often find that the underlying logic of US healthcare requires a different vocabulary. Separate pharmacy and medical benefit systems, multiple payer types, and pricing benchmarks such as WAC and ASP all shape how medicines are covered, reimbursed and paid for in the US.
Understanding these terms is a practical first step before working on global pricing strategy, payer negotiations, reimbursement planning or market access discussions with US-based colleagues.
Key US market access terms explained
- WAC: Wholesale Acquisition Cost
The list price for pharmacy benefit drugs in the US. This is the benchmark price before discounts or rebates are applied.
- ASP: Average Sales Price
The price used to calculate reimbursement for medical benefit drugs.
- AWP: Average Wholesale Price
A pricing benchmark used for pharmacy benefit drugs.
- Medical benefit vs pharmacy benefit
Medical benefit covers healthcare professional services and drugs administered by healthcare professionals. Pharmacy benefit covers drugs that patients or caregivers administer themselves, usually obtained through a retail pharmacy. This distinction is often unfamiliar to professionals coming from European pricing and reimbursement systems.
- PBM: Pharmacy Benefit Manager
PBM stands for Pharmacy Benefit Manager. PBMs are important stakeholders in the US pharmacy benefit landscape.
- CMS: Centers for Medicare & Medicaid Services
CMS is the federal body responsible for setting drug reimbursement rates, among other roles.
- Medicare and Medicaid
Medicare is the federal program providing health services to people over 65 and certain other groups. Medicaid is the federal and state program providing health services to people with low income.
- 340B
A federal program that allows hospitals treating financially vulnerable patients to buy outpatient drugs at a discount.
- Prior authorization, step edit and quantity limit
These are utilization management tools used by US insurers to control how and when a drug is covered. Prior authorization sets requirements before a prescription or procedure is covered. A step edit requires the patient to try one or more treatments in sequence. A quantity limit defines how much of a drug can be dispensed within the insurance policy.
- IRA: Inflation Reduction Act, 2022
IRA stands for the Inflation Reduction Act, 2022. In this glossary, it is linked to the concept of maximum fair price, the price determined for selected high-spend Medicare drugs following negotiation.
- Most favored nation policy
A policy aimed at lowering prescription drug prices by aligning them with prices paid in a selected group of other countries.
This is a partial list. The full glossary covers more than 25 essential terms, including co-insurance, co-payment, deductible, GPO, HCPCS, NDC, P&T committee, tier, and the different parts of Medicare.
Download the full glossary
Get the complete US Market Access Glossary as a free PDF reference, including definitions for more than 25 US market access, pricing, reimbursement and payer terms.
Keep it on hand when preparing for US pricing discussions, reimbursement planning, payer strategy work or conversations with US-based colleagues.
Frequently Asked Questions
Medical benefit covers healthcare professional services and drugs administered by healthcare professionals. Pharmacy benefit covers drugs that patients or caregivers administer themselves, usually obtained through a retail pharmacy.
WAC stands for Wholesale Acquisition Cost. It is the list price for pharmacy benefit drugs.
PBM stands for Pharmacy Benefit Manager. It is a key term in US market access and pharmacy benefit discussions.
US market access terminology is different because the US system uses multiple public and private payer structures, separate medical and pharmacy benefits, and specific pricing and reimbursement benchmarks such as WAC and ASP. These concepts are often unfamiliar to professionals used to European pricing and reimbursement systems.
Yes. The glossary is useful for European and other non-US pharmaceutical professionals who need to understand US market access terminology for global roles, cross-functional projects or collaboration with US teams.
The glossary includes definitions of commonly used US market access terms, including 340B, ASP, AWP, CMS, co-insurance, co-payment, Medicare, Medicaid, PBM, prior authorization, step edit, WAC and more.
Continue your learning from Nick and Louisa
If you’d like to learn more from Nick and Louisa, CELforPharma also offers a 1-day, hands-on course where you'll:
- Understand the structure and key players of the US managed care system
- Distinguish between medical and pharmacy benefits and how pricing and access controls differ between them
- Clarify the role and influence of Pharmacy Benefit Managers (PBMs)
- Explore the implications of recent US policy developments
- Recognise common challenges and approaches to US market access
Understanding Pharma Market Access in the US
With Dr Nick Proctor & Louisa Oliver Byrne
Don’t miss the latest insights from our expert faculty
Subscribe to our newsletter to:
- Stay on top of the latest expert insights
- Receive invitations to upcoming educational webinars
- Get updates on our courses and training programmes